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Cureus May 2024Left atrial appendage occlusion (LAAO) devices have emerged as a promising alternative for stroke prevention in non-valvular atrial fibrillation...
Left atrial appendage occlusion (LAAO) devices have emerged as a promising alternative for stroke prevention in non-valvular atrial fibrillation (NVAF) patients with contraindications to chronic anticoagulation therapy. The most common life-threatening procedural complications described in the literature include pericardial effusion, air embolism, and stroke. We here present a case report of two patients who experienced identical but rare post-procedural complications of pulmonary venous bleed, presenting as hemoptysis.
PubMed: 38947731
DOI: 10.7759/cureus.61451 -
Cureus May 2024Iliac vein stenting is performed when sufficient venous patency is not achieved via angioplasty or lysis. Iliac vein stenting is known to be effective; however,...
Iliac vein stenting is performed when sufficient venous patency is not achieved via angioplasty or lysis. Iliac vein stenting is known to be effective; however, occlusion of the stent occurs occasionally. There is a lack of effective treatment options for those with failed prior venous stents, and traditional methods may involve the removal of the stent and surgical reconstruction. We present a patient with a right leg post-thrombotic syndrome and narcotic abuse after occlusion of a previously placed right common iliac/external iliac vein stent 25 years prior. After transfer to an office-based lab (OBL), femoral vein access was achieved. Then, a second stent was deployed adjacent to the previously chronically thrombosed stent. Imaging confirmed adequate deployment of the new stent and venous flow. Treatment resulted in a significant decrease in patient pain and cessation of narcotics. We demonstrate successful recanalization of a right iliac vein thrombosis via parallel deployment of a stent adjacent to a chronically thrombosed stent.
PubMed: 38947725
DOI: 10.7759/cureus.61298 -
Cureus May 2024Coronary artery disease continues to remain the leading cause of mortality worldwide. Coronary blood supply is provided through the right and left main coronary...
Coronary artery disease continues to remain the leading cause of mortality worldwide. Coronary blood supply is provided through the right and left main coronary arteries. The left main coronary artery (LMCA) in turn gives rise to the left anterior descending (LAD) and left circumflex (LCX) arteries. In some cases, LMCA may trifurcate into the ramus intermedius (RI) in addition to the LAD and LCX arteries. Atherosclerotic plaque formation and rupture with subsequent clot formation and occlusion of coronary arteries are the underlying mechanisms of myocardial infarction. Though the clinical implications of the presence of ramus intermedius (RI) are controversial some data suggest that the RI is associated with an increased risk of atherosclerotic plaque formation in the LMCA and the proximal LAD. Conversely, it has been proposed that the RI provides an additional collateral source of blood supply to the myocardium and may potentially contribute to improved survival. Case reports tout the benefits of RI, specifically in the setting of multivessel coronary artery occlusions. Whether it increases the risk of atherosclerotic plaque formation or whether it is protective has yet to be determined. We present a case of a 58-year-old male who presented with acute coronary syndrome and cardiogenic shock due to total ostial occlusion of LAD. The patient had also chronic total occlusions of the right coronary artery and LCX but a patent RI, which was the only source of blood supply to the myocardium and practically determined the patient's survival. Additionally, we performed a literature review to identify similar cases, to support RI's potentially protective role in enhancing survival.
PubMed: 38947610
DOI: 10.7759/cureus.61288 -
Cureus May 2024A 79-year-old female with chronic atrial fibrillation was being treated with dabigatran (Pradaxa). Pradaxa was discontinued after a significant bleeding episode. A...
A 79-year-old female with chronic atrial fibrillation was being treated with dabigatran (Pradaxa). Pradaxa was discontinued after a significant bleeding episode. A WATCHMAN device was successfully implanted and Pradaxa was started. A transesophageal echocardiogram (TEE) 49 days later showed a 3.6×2.2 cm clot overlying the device. Pradaxa was switched to Coumadin. Subsequent TEEs showed the complete resolution of the thrombus after five months on Coumadin. Coumadin was discontinued. Six months later, TEE showed a large mobile thrombus attached to the left atrial appendage occlusion device (LAAOD). The patient's hypercoagulable workup was negative. Due to recurrent thrombotic events, she was started on apixaban (Eliquis) due to a prior history of bleeding on Coumadin. She is currently on Eliquis with no further episodes of bleeding or device thrombus.
PubMed: 38947599
DOI: 10.7759/cureus.61368 -
Cureus May 2024The tongue supports the upper dental arch and encourages healthy dental arch development when it rests against the roof of the mouth. On the other hand, over time,... (Review)
Review
The tongue supports the upper dental arch and encourages healthy dental arch development when it rests against the roof of the mouth. On the other hand, over time, malocclusion can result from incorrect tongue position, such as lying low in the mouth or thrusting forward during swallowing or speaking. As a muscular organ, the tongue applies forces to the jaws and teeth that may help with malocclusion or hinder it from aligning properly. The dentition and jaws grow and align according to the way the tongue, teeth, and surrounding structures interact. The tongue's morphogenetic function includes forming the arches and having an important impact on the maxillary complex's development. The tongue frequently assumes a balancing and compensatory function in subsequent phases, functioning more or less like a natural orthodontic bite. In adults, the tongue is able to compensate for problems like open bites, teeth that are out of alignment, or differences in the occlusal and sagittal planes of the spine. In this context, the tongue's ability to sustain occlusion during malocclusion can be considered a compensatory response. This is comparable to how lingual dysfunction may contribute to malocclusion or act as a potential source of recurring orthodontic instability. In order to diagnose and treat orthodontic issues, dental professionals must know the connection between tongue position and dental malocclusion. Malocclusion can be prevented or minimized with early intervention, such as myofunctional therapy to correct tongue position and habits, improving dental health and well-being overall.
PubMed: 38947580
DOI: 10.7759/cureus.61281 -
Journal of Cell Communication and... Jun 2024Microglia are resident immune cells in the central nervous system that are rapidly activated to mediate neuroinflammation and apoptosis, thereby aggravating brain tissue...
Microglia are resident immune cells in the central nervous system that are rapidly activated to mediate neuroinflammation and apoptosis, thereby aggravating brain tissue damage after ischemic stroke (IS). Although scutellarin has a specific therapeutic effect on IS, the potential target mechanism of its treatment has not been fully elucidated. In this study, we explored the potential mechanism of scutellarin in treating IS using network pharmacology. Lipopolysaccharide (LPS) was used to induce an in vitro BV-2 microglial cell model, while middle cerebral artery occlusion (MCAO) was used to induce an in vivo animal model. Our findings indicated that scutellarin promoted the recovery of cerebral blood flow in MCAO rats at 3 days, significantly different from that in the MCAO group. Western blotting and immunofluorescence revealed that scutellarin treatment of BV-2 microglial cells resulted in a significant reduction in the protein expression levels and incidence of cells immunopositive for p-NF-B, TNF-, IL-1, Bax, and C-caspase-3. In contrast, the expression levels of p-PI3K, p-AKT, p-GSK3, and Bcl-2 were further increased, significantly different from those in the LPS group. The PI3K inhibitor LY294002 had similar effects to scutellarin by inhibiting neuroinflammation and apoptosis in activated microglia. The results of the PI3K/AKT/GSK3 signaling pathway and NF-B pathway in vivo in MCAO models induced microglia at 3 days were consistent with those obtained from in vitro cells. These findings indicate that scutellarin plays a neuroprotective role by reducing microglial neuroinflammation and apoptosis mediated by the activated PI3K/AKT/GSK3/NF-B signaling pathway.
PubMed: 38946727
DOI: 10.1002/ccs3.12023 -
Journal of Indian Prosthodontic Society Jul 2024The orchestration of jaw relations in edentulous scenarios poses a significant challenge, demanding acumen, and expertise from the clinician. A myriad of devices,...
BACKGROUND
The orchestration of jaw relations in edentulous scenarios poses a significant challenge, demanding acumen, and expertise from the clinician. A myriad of devices, substances, and methodologies are employed to gauge the transverse, vertical, and horizontal spectrums of jaw relations. Traditionally, a synthesis of assorted devices and techniques has been requisitioned to chronicle the spatial dynamics between the maxilla and mandible. Yet, the absence of a solitary apparatus capable of concurrently documenting the triad of jaw relations has been a notable lacuna in prosthodontic rehabilitation.
PURPOSE
This discourse expounds on an innovative contrivance, termed the Precise Jaw Relation Recorder. This pioneering instrument is adept at capturing the tripartite jaw relation processes: the occlusal plane's alignment in parallelism to the ala-tragus line, the vertical dimension at repose, and the occlusion as well as the centric relation. The device's strategic utility lies in its ability to facilitate the creation of prostheses that are not only functionally superior but also aesthetically more pleasing.
CONCLUSION
Its implementation is a stride toward refining the accuracy of prosthodontic outcomes, thereby elevating the standard of patient care in dental practice.
Topics: Humans; Jaw Relation Record; Prosthodontics; Dental Occlusion
PubMed: 38946515
DOI: 10.4103/jips.jips_530_23 -
Journal of Indian Prosthodontic Society Jul 2024The aim of this study is to evaluate the influence of occlusion on body posture and plantar arch pressure. (Observational Study)
Observational Study
AIM
The aim of this study is to evaluate the influence of occlusion on body posture and plantar arch pressure.
SETTINGS AND DESIGN
An Observational analysis to Analyze the Influence of Occlusion on Plantar Pressure and Body Posture.
MATERIALS AND METHODS
A total of 30 asymptomatic subjects were selected for the study including 18 females and 12 males from age group 22 years to 28 years with a mean age of 24.83 years. Each subject underwent evaluation of occlusion at MIP using a Digital Occlusal analyzer (T-Scan III). At this point, the subjects were made to stand on a mat scan which consisted of a large postural platform sensor and a computer that displayed the plantar pressure data. The computer connected to the T Scan displayed the occlusal pressure analysis. This was followed by an evaluation of body posture using a posture grid where the photographs were taken and an evaluation of the frontal and lateral photos was done using the APECS - posture analysis app.
STATISTICAL ANALYSIS USED
Statistical package for social sciences (SPSS) for windows version 22.0 Released 2013, Armonk, N Y: IBM Corp., was used to perform Statistical Analysis. A chi-square test was applied for qualitative variables to find the association. Paired t-test was applied to compare the changes in the quantitative parameters in eye-open and eye-closed conditions. The level of significance was set at 5%.
RESULTS
As observed from the results, occlusion for 40% of the subjects, where n = 12, was dominant on the right side. Occlusion for 23.3% of subjects, where n = 7, was dominant on the left side. Whereas, for 36.7% of subjects, where n = 11, the pressure distribution was almost equal on both sides. The inclination of body posture for 23.3% of subjects, where n = 7, was towards the right side. The inclination of body posture for 50% of subjects, where n = 11, was towards the left side. And, the inclination of body posture for 26.7% of subjects, where n = 8, was neutral i.e., balanced on the right and left side. Plantar pressure for 6.7% of subjects, where n = 2, was dominant on the right side. Plantar pressure for 36.7% of subjects, where n = 11, was dominant on the left side. Whereas, for 56.7% of subjects, where n = 17, the plantar pressure distribution was almost equal on both sides.
CONCLUSION
On correlating the three parameters, it was found that occlusion for most of the subjects dominated on the right side, while body posture and plantar pressure dominated on the contralateral i.e., left side.
Topics: Humans; Male; Female; Posture; Adult; Pressure; Young Adult; Foot; Dental Occlusion
PubMed: 38946511
DOI: 10.4103/jips.jips_497_23 -
Journal of Indian Prosthodontic Society Jul 2024Assessment of occlusion changes during laboratory phase of relining is essential to evaluate the occlusal discrepancies that could get incorporated in the denture with...
AIM
Assessment of occlusion changes during laboratory phase of relining is essential to evaluate the occlusal discrepancies that could get incorporated in the denture with the use of different relining materials. Since the long term stability and functional success of the denture is heavily influenced by occlusion, an In-vitro study to assess these changes after relining is warranted. The aim of the study is to evaluate the changes in occlusion during laboratory phase of relining procedure.
SETTINGS AND DESIGN
This is an in vitro study with a total of 30 specimen.
MATERIALS AND METHODOLOGY
A total of 30 maxillary standardized dentures were fabricated after mounting on a semi adjustable articulator. These samples will be divided into three groups based on the relining material used (Autopolymerizing resin, Heat-cure resin, Tissue conditioner). The vertical dimension, Centric contact points and eccentric contact points were measured before and after relining.
STATISTICAL ANALYSIS USED
The variables were tested to see if they had a normal distribution using the Shapiro-Wilk test. Parametric distribution was seen for ECP leading to further comparison using one way analysis of variance (ANOVA). Non-parametric distribution was found while testing the VD, CCP leading to adoption of Kruskal-wallis test for comparison of groups. Dunn Bonferroni test was done for VD since results were significant.
RESULTS
The results of this in-vitro study showed statistically significant difference with respect to change in vertical dimension in all groups pre and post relining (P = 0.005). The centric contact points showed lesser variation in position when comparing the pre to the post relining phase with the use of autopolymerising resins, whereas heat cure resins and tissue conditioners showed statistically significant difference in the centric point contacts post relining. No statistically significant changes were seen in eccentric occlusion post relining in all groups. Tissue conditioners showed minimum mean changes in eccentric contacts.
CONCLUSION
Within the limitations of this study, the use of autopolymerising resins depicted the most stable results with respect to occlusion, for relining of dentures.
Topics: Humans; In Vitro Techniques; Dental Occlusion; Denture Retention; Dental Materials; Denture Liners
PubMed: 38946509
DOI: 10.4103/jips.jips_363_23 -
Neurointervention Jul 2024The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVOs). We evaluated technical...
PURPOSE
The direct aspiration first pass technique (ADAPT) is an effective and safe endovascular treatment for distal medium vessel occlusions (DMVOs). We evaluated technical features and initial results of a novel reperfusion catheter (REDTM 62) used for frontline aspiration thrombectomy of M2 occlusions in acute ischemic stroke patients. Appropriate aspiration catheters are crucial for a successful ADAPT maneuver; however, the selection of catheters suitable for smaller-sized vessels is scarce compared to the ones for large vessel occlusions.
MATERIALS AND METHODS
All patients treated with ADAPT using REDTM 62 as the frontline treatment approach for acute M2 occlusions between December 2022 and February 2024 were retrospectively enrolled. Demographic data, procedural timings and safety, recanalization rates, and outcome data were recorded.
RESULTS
Twenty patients with a median admission National Institutes of Health Stroke Scale (NIHSS) score of 8 were identified. Successful revascularization (DMVO-thrombolysis in cerebral infarction [TICI]≥2b) with REDTM 62 aspiration thrombectomy was obtained in 65.0% (13/20) of cases. The first pass effect was 45.0% (9/20). In 2 cases, the REDTM 62 did not reach the clot due to marked distal vessel tortuosity. Stent retrievers were additionally used in 9 cases and led to an overall DMVO-TICI 2c/3 of 90.0% (18/20). Mean procedural time was 48 minutes. No complications directly related to ADAPT occurred. In-hospital mortality rate was 20.0% (4/20). The median discharge NIHSS score was 2.5. A good functional outcome at discharge (modified Rankin scale 0-2) was achieved in 55.0% (11/20) of cases.
CONCLUSION
Our initial experiences with the novel REDTM 62 reperfusion catheter for treatment of M2 occlusions is in line with published data. ADAPT using this catheter may be considered as a safe and effective first-line treatment option. Further studies are warranted to validate the initial results.
PubMed: 38946131
DOI: 10.5469/neuroint.2024.00171